Gastrostomy feeding apparatus and method

Abstract

An apparatus for direct gastric feeding via a gastrostomy tract formed in a patient. The apparatus includes a tube, an internal bolster, an external bolster, and a force-generating device. The force-generating device may include a pair of automatically adjustable spring members on the external bolster. The spring members are responsive to changes in the length of the gastrostomy tract and eliminate the need for periodic adjustment or replacement of the apparatus.

What is claimed is: 
     
       1. Gastrostomy feeding apparatus for providing enteral nutrition to a patient via a gastrostomy tract formed in the patient, said apparatus comprising:
 a tube defining a feeding lumen having an axis, said tube having first and second opposite ends and being adapted to be positioned in said gastrostomy tract for delivering enteral nutrition to the patient; 
 an internal bolster connected to the tube generally adjacent the first end of the tube, said internal bolster being adapted to be positioned inside the stomach of the patient; 
 an external bolster connected to the tube generally adjacent the second end of the tube, said external bolster being adapted to be disposed outside the patient; and 
 a force-generating device having a first end attached to the external bolster and a second end free of connection to the internal bolster and spaced from the internal bolster so that when the internal bolster is positioned against a wall of the stomach the external bolster and force-generating device are located entirely outside of the patient, the second end of the force-generating device being operatively engaged with the exterior of the patient when the internal bolster is positioned against the wall of the stomach to exert a force on the patient and in an axial direction with respect to the tube tending to hold the internal bolster in pressure contact with the stomach wall, said force-generating device having a length in said axial direction which varies bidirectionally and automatically in response to a change in the length of the gastrostomy tract to maintain said pressure contact without manual adjustment of the apparatus; 
 wherein said force-generating device comprises a spring device comprising at least two spring members connected to said external bolster adjacent a periphery of the bolster and generally on opposite sides of said axis, each of said at least two spring members having a first end connected to the external bolster and an opposite second end adapted to react against the patient for exerting said force. 
 
     
     
       2. The apparatus of  claim 1 , wherein the internal and external bolsters have openings therein aligned with said feeding lumen to define a passage for receiving a feeding tube for supplying nutrition to the patient. 
     
     
       3. The apparatus of  claim 2 , further comprising a closure tethered to the external bolster for closing the opening in the external bolster. 
     
     
       4. The apparatus of  claim 1 , wherein each of said at least two spring members comprises an axially expansible and contractible spring portion, and a foot portion connected to said spring portion at said second end of the spring member for contact with the patient, the foot portion having an enlarged force spreading surface for contacting and reacting against the patient. 
     
     
       5. The apparatus of  claim 1 , wherein each of said at least two spring members comprises a plurality of elastic pleats extending along arcs centered on said axis. 
     
     
       6. The apparatus of  claim 1 , wherein the internal bolster is spaced from the second end of each of said at least two spring members by an axial distance between 0.10-0.25 in. when the spring members are in a fully extended, relaxed condition. 
     
     
       7. The apparatus of  claim 1 , wherein each spring member of said at least two spring members expands and contracts independent of the other spring member of said at least two spring members. 
     
     
       8. The apparatus of  claim 1 , wherein the internal bolster comprises a retention structure contractible in a radial direction to permit insertion through the gastrostomy tract and expansible in a radial direction to resist withdrawal from the gastrostomy tract. 
     
     
       9. The apparatus of  claim 1 , wherein the internal bolster comprises a first end section connected to the first end of the tube and the external bolster comprises a second end section connected to the second end of the tube, said first and second end sections having a first outside diameter and the tube having a second outside diameter less than said first outside diameter. 
     
     
       10. The apparatus of  claim 1 , in combination with one or more of the following: one or more placement obturators, one or more bolus feeding sets, one or more continuous feeding sets, and one or more insertion/removal devices. 
     
     
       11. The apparatus of  claim 1 , wherein each of the spring members of said at least two spring members extends from the external bolster along an axis generally parallel to the axis of the lumen towards the internal bolster. 
     
     
       12. A method of securing gastrostomy feeding apparatus to a gastrostomy tract of a patient, said method comprising:
 providing gastrostomy feeding apparatus comprising internal and external bolsters connected by a tube defining a feeding lumen having an axis, and a force-generating device extensible and contractible in an axial direction with respect to the tube, said force generating device being attached to the external bolster; and 
 inserting the internal bolster through the gastrostomy tract of the patient to a position in which: (i) the internal bolster is inside the stomach of the patient; (ii) the tube is in the gastrostomy tract; and (iii) the force-generating device is exerting a force tending to hold the internal bolster in pressure contact with a wall of the stomach, the force generating device is disposed entirely outside the patient, and the force-generating device varying bidirectionally and automatically in length in said axial direction in response to a change in the length of the gastrostomy tract thereby maintaining said pressure contact without manual adjustment of the gastrostomy feeding apparatus; 
 wherein said force-generating device comprises a spring device comprising at least two spring members connected to said external bolster adjacent a periphery of the bolster and generally on opposite sides of said axis, each of said at least two spring members having a first end connected to the external bolster and an opposite second end adapted to react against the patient for exerting said force. 
 
     
     
       13. The method of  claim 12  further comprising inserting a feeding tube through said feeding lumen, and supplying nutrition to the patient through the feeding tube. 
     
     
       14. The method of  claim 12  wherein inserting the internal bolster through the gastrostomy tract includes placing a foot portion of the force generating device against an exterior surface of the patient so that the foot portion bears against the exterior surface of the patient and the force generating device urges the external bolster away from the exterior surface of the patient.